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Home My WebLink AboutBUSINESS PLAN UNIFIED PROGRAM INSPECTION CHECKLIST :€SY+:.e*;.s~E3R;5~ ',~.n ~2"AYE.*.AZi'F.'~iL~..~'Aifi9$u.: t~Tx3c.P F.F v.. ,,".`Y.: r.7P ...;. ;•:' ~ ..: :'~,..:v.. ;' ».l'.:: ! K ~: ~'~>i, .:i... .~:', t.:y~ ••,-~;:, SECTION 1: Business Plan and Inventory Program :f • BAKERSFIELD FIRE DEPT a p Prevention Services r/t~ 9001Yuxtun Ave., Suite 210 wRrM T Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME INSPECTION DATE INSPECTION TIME ~ ~' f A~ ~~/~CTt~'G4P-~ r100 10 1 6~ ~0 ~`h ADDRESS / ( - HONE NO. O OF EMPLOYEES r y~ (~' FACILITY CONTACT USINESS ID NUMBER 15-021-G2~3.~/ 7 Section 1: Business Plan and Inventory Program `301 ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION • C V (c=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND C~ . ^ BUSIII2SS PLAN CONTACT INFORMATION ACCURATE L~ ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY / ^ VERIFICATION OF INVENTORY MATERIALS I~D ^ VERIFICATION OF QUANTITIES ~~ ^ VERIFICATION OF LOCATION Q 'Q vv ~j ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND ROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING C~ ^ (( FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITES EXPLAIN: ^ YES ~NO .QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~~~ ~~ ~ ~ Inspector (Please Print) Fire Prevention / 1°' In / Shift of Site/Station # White -Prevention Services Yellow -Station Copy Pink -Business Copy FD2049 (Rev. 0?J05) °0 APRIA HEALTI3CARE® 414 19th Street Bakersfield, California 93301 ~ ~_ ~ c ~~ t ~~~~ ~NT'D ~~'~ ~ ~ ~~Q~ ~33~~ r~ i IA(~f~~v~ ~-taw-(`~Ff- ~d~-~2~- ~a4-S W~J~c~ 4i4 ~~~~ +-(Z6~Y~ r4--S ~~ ~.~~ ;~S S. ~.- ~v l-DCp~ ~~~~ ~1~~ V V~ ~ 2~ ~- Ce Ce ~ r i ~-1-an/K ~ a~ "5 pp`~ ~b cue a S~~ ~~,\ ~~ ~~ ~~ ~,,9~ ~"`~ ~ ~ sa- - ~~' ~a~ - - - - - 0 \~0 ~ p ,. ~~ ~ - ~ RENEE MIRELEZ ~ ~ Branch Manager ~ APRIA HEALTHCARE® ~~ 414 19th Street, Bakersfield, CA 93301 ~ 1 Tel (66]) 324-4887 / (800) 678-4645 ~~ Fax (661) 324-0581. ~ j Renee_Mirelez@Apria.com JCAHO Accredited I + APRIA HEALTHCARE 5100 _______________________________ SiteID: 015-021- + I~~.j~t~. Vy1 ! 2~(~2- Manager BusPhone: (661} 324-4887 Location: 414 19TH ST Map 103 CommHaz Low City BAKERSFIELD Grid: 30B FacUnits: 1 AOV: CommCode: BFD STA O1 EPA Numb: SIC Code:4925 DunnBrad:97-31229 Emergency Contact / Title Emergency Contact / Title / LOGISTIC SUPR / BRANCH MANAGER Business Phone: (661) 324-4887x Business Phone: (661) 324-4887x 24-Hour Phone ((g(g()Ce j~ ~~~~ 24-Hour Phone ((,Q(p() 20( -og~ Pager Phone ( Pager Phone Hazmat Hazards: Fire Press ImmHlth DelHlth Contact Phone: (661) 324-4887x MailAddr: 414 19TH ST Stater CA City BAKERSFIELD Zip 93301 - ----------------- - -~.~~}~ ~-r~----- Owner ~--'~ ~ (~~ ~.-~ 0 Phone : (~ ~~a.:z-=a.~~1~ Address Z-(OZ_~3 ~il~J~~~ Ste' State • CA _ Clty C~nmr wennT ~W iL~ri ~-t~~2,(~{,~T Zlp 9263®-- ~~0~ +---------------------------------- ~t-1--- Period to `/ ~~~ TotalASTs: _ - Gal+ Preparers O rlO TotalUSTs: = Gal Certif'd: ~~~~~(o RSs: No ParcelNo: Emergency Directives: ~O~ PROG A- HAZMAT ~ O~~ ENT'D J U L 2 4 2006 ~{M~~ 550 -1- 05/15/2006 Based on my inqquiry of tho~~ irldi~tiduals responsible for obtalnihq they I~toFtn~tit9r~, i f;Qrtify under penalty of lava that I have personally examined and am famAlar wlth the information submitted and beli~va the inf~rrrtation is trop. ~ _ .. =' AFI,R.TAHEALTHCARE 5100 ,, Manager RENEE MIRELEZ Location: 414 19TH ST City BAKERSFIELD CommCode: BFD STA 04 EPA Numb: BusPhone: Map 103 Grid: 30B SIC Code: DunnBrad: SiteID: 015-021-003317 (661) 324-4887 CommHaz Low FacUnits: 1 AOV: Emergency Contact / Title Emergency Contact / Title GABE NAVA / LOGISTICS SUPR RENEE MIRELEZ / BRANCH MANAGER Business Phone: (661) 324-4887x Zp[~ Business Phone: (661) 324-4887x Zl~~ x 24-Hour Phone (661) 619-589 8 24-Hour Phone (661) 201-0983x Cr / c Phone ((e(,e()~I ~ ~ `~-- P n Q,C(,2()'~d ?j -~ Hazmat Hazards: Fire Press ImmHlth DelHlth Contact LARRY HIGBY Phone: (949) 639-2000x MailAddr: PO BOX 610 State: CA City LAKE FOREST Zip 92609-0610 Owner APRIA HEALTHCARE Phone: (949) 639-2000x Address 26220 ENTERPRISE CT State: CA City LAKE FOREST Zip 92630-8405 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif~d: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ~N~ F~ e e z s ~~ o~ QasE:d on my inquiry of those individuals responsible for obt i a ning the information, I certify under penalty of law that 1 have perso exa i m nally ned and am familiar with the inf ormation submitt and believe the information is true, accur , and complete. i Si ------_..._.... [ Date -1- 01/24/2007 F APRIA"HEALTHCARE 5100 SiteID: 015-021-003317 ~ ~`Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN LIQUID OXYGEN F F P IH DH IH G L 15002.00 160.00 FT3 GAL LOw Low -2- 01/24/2007 -3- 01/24/2007 F APRIA`HEALTHCARE 5100 'Inventory Item 0001 COMMON NAME / CHEMICAL NAME OXYGEN Location within this Facility Unit STATE TYPE PRESSURE _ Gas TPure ~-Above Ambient SiteID: 015-021-003317 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 7782-44-7 TEMPERATURE CONTAINER TYPE - Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Co251100rFT3 Dai115002100m FT3 I Daily A50r00e FT3 rltic~titcLVUa ~.vrlrvlvrJlvl~ %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 LIHGKCCL EiJ Jl',JJ1"1L~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME LIQUID OXYGEN _ Days On Site 365 Location within this Facility Unit Map: Grid: ON TRUCKS THAT ARE FILLED AT AIRGAS IN THE MORNING AND CAS# RETURN TO THE BRANCH NEARLY EMPTY AT THE END OF THE DAY 7782-44-7 Liquid TPureE ~AboveSAmbEent AmbientT~E _ PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 160.00 GAL 160.00 GAL 160.00 GAL lu~uralcLVVJ l..Vl•lr V1V I/1V1J %Wt• RS CAS# 100.00 Oxygen, Compressed No 7782447 rlti[~tuCL tiJ JP.~J J1"1P~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -4- 01/24/2007 F APRIA~HEALTHCARE 5100 SiteID: 015-021-00331.7 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification Employee Notif./Evacuation 05/18/2006 ALERT YOUR IMMEDIATE MANAGER OR SUPERVISOR OF THE SITUATION. SECURE THE RELEASE AREA AND PROHIBIT OTHERS FROM ENTERING THE AREA. PREPARE TO RECEIVE EVACUATION DIRECTION FROM YOUR SUPERVISOR OR MANAGER. NOTIFY THE LOCAL FIRE AUTHORITY. _,_ , ,~ rw.~i ice, ivv l.lt ~ L,VCL I: UCLL1Vll rlllCiyCllC:y 1"1CU1C:d1 Y1di1 oZ Q~" C ~ s ~ c ~ ~- ~P ~~- -5- 01/24/2007 F APRIA'HEALTHCARE 5100 SiteID: 015-021-003317 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention ---- Release Containment 10/16/2006 ATTEMPT TO STOP OR RESTRICT THE SPILL BY: CLOSING THE VALVE, TURNING THE CONTAINER UPRIGHT OR SPREADING ABSORBENT MATERIALS, PADS, BOOMS, ETC. Clean Up 01/18/2006 CLEAN-UP SHOULD BE HANDLED BY THE EMPLOYEE THAT SPILLED THE MATERIAL. U1~11C1 1CCSU U.LUC LiU lrlVdl~1U11 -6- 01/24/2007 F APRIA'HEALTHCARE 5100 SiteID: 015-021-003317 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ special tiazaras Utility Shut-Offs 11/08/2006 NATURAL GAS/PROPANE: MAIN SHUT-OFF IN ALLEY W SIDE OF BLDG ELECTRICAL: 2 PANELS IN WHSE, ONE PANEL IN BACK OFFICE, MAIN BLDG PANEL IN ALLEY W SIDE OF BLDG WATER: MAIN SHUT-OFF SE SIDE OF BLDG SPECIAL: NONE LOCK BOX: NO Fire Protec./Avail. Water 01/24/2007 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS IN ALL BLDG SUITES AND VEHICLES . ~~~/_ NEAREST FIRE HYDRANT - S OF BLDG S SIDE~i ST. Building Occupancy Level 26 EMPLOYEES 07/24/2006 -7- 01/24/2007 t "J F API2IA~HEALTHCARE 5100 SiteID: 015-021-003317 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/18/2006 ~ BRIEF SUMMARY OF TRAINING PROGRAM: VIDEO IN-SERVICE, ALONG WITH A 30-50 QUESTION TEST, DEPENDING ON JOB TITLE. TRAINING INCLUDES DISTRIBUTION OF HAZARDOUS MATERIALS, HANDLING OF HAZARDOUS MATERIALS, AND SAFETY OF HAZARDOUS MATERIALS. HANDS-ON TRAINING IS ALSO PART OF THE PROGRAM. Ydt~C G aic iu. i.vi i-u~..utc vac i1C 111 1VL t uLUIC U5C -8- 01/24/2007 ,: RPRi~ ~IIN I'~ ~n ~ F«~ H~ un-a~T Y ~~ G/1~~~ ~ ~y ~ ~ ' ~ S~ 1 ,~ •, ;, .,~ f ~ ~~. ~; - j i iiI ~ ~ ~ J / ~ ~i I I ~p ~ i I . __..., ~, i ~~~ . ~~' 3 ,r Bt11LDfNG ~ 02- ~S (~ / >4 ~._._..~._.__._.~.._._. ~:~ ._._s~~ ._._._._._._._._._._._ Sf 33!? N .~ ~. s ;~ , / i ,- t. i / i ~ ~ l I i ~/ u ~~ ~ ~ ~ ~ I 1 tat r:~.m vtapp IOt .. 7 /. - l ~°"~ - ---...--~----~ ,=-. ...w...._...~..._..._......~......_.~.?~?~ .~..._s,~~ ._.._..._.__~._._._._..~.~._._.. r ~`~ "~~` f